HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit IV

Upon completion of this unit, students should be able to:

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.
2.1 Discuss how health care ethics committees work.
2.2 Explain how ethics are applied to critical health care issues.

6. Summarize the government’s impact on health care regulations and reform.

6.1 Discuss critical issues regarding U.S. health care reform.

Course/Unit
Learning Outcomes

Learning Activity

2.1, 2.2

Unit Lesson
Chapter 6
Chapter 11
Unit IV Essay

6.1

Unit Lesson
Chapter 6
Chapter 11
Unit IV Essay

Required Unit Resources

Chapter 6: Healthcare Ethics Committees: Roles, Memberships, Structure, and Difficulties

Chapter 11: A New Era of Health Care: The Ethics of Healthcare Reform

Unit Lesson

In this unit, we will discuss critical issues for health care organizations. Specifically, we will learn about health
care ethics committees: roles, memberships, structure, and difficulties. We will also discuss the ethics of
health care reform.

Ethics Committees

Health care is in an era of intense change, including the uncertainty of the Affordable Care Act of 2010; the
demand for technology; and changing demographics which all pose service, ethical, and fiscal challenges
(Morrison & Furlong, 2019). The engagement of ethics committees in both clinical and policy roles can help a
health care organization meet these intense demands and changes. Traditionally, a health care organization’s
ethics committee had the roles of case consultation, policy development assistance, and education, but each
of these roles needs to be expanded to meet the challenges that a health care organization may face
(Morrison & Furlong, 2019).

Situations involving health care organizations, clinicians, patients, and families often involve difficult decisions
and raise ethically challenging questions regarding the appropriate course of action (American Medical
Association [AMA], n.d.). Ethics committees can assist with decisions regarding informed consent, organ
procurement, withholding or withdrawing life-sustaining treatments, and advance directives. Ethics
committees also can assist with educating health care providers and patients about various issues in clinical
ethics (Pearlman, 2013). In this type of situation, ethics committees provide assistance in making decisions
that reflect the patients’ interests, concerns, and values (AMA, n.d.).

UNIT IV STUDY GUIDE
Critical Issues for Health
Care Organizations

HCA 3302, Critical Issues in Health Care 2

UNIT x STUDY GUIDE
Title

Around the 1970s, ethics committees for patient care began to develop. In 1992, the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) was established because of a need for health care
organizations to have a standard means of addressing ethical issues and conflict (Morrison & Furlong, 2014).

Hospital ethics committees have three main functions:

1. to create procedures and policies;
2. to train and educate staff; and
3. to conduct clinical consultations.

Individuals with a wide range of expertise and backgrounds often make up ethics committees. It is important
for the members of the ethics committee to be diverse because this is effective in decision-making (Morrison
& Furlong, 2014). The members of ethics committees often include administrators, bioethicists, hospital board
members, and clinicians.

Ethics committees began in response to difficult patient issues. Issues in health care relating to ethics happen
all throughout a health care organization. On a daily basis, hospital administrators and clinicians are
challenged with making difficult health care decisions, which increases the demand for ethical oversight. Due
to this, health care organizations must maintain and hire staff who are well-versed in ethical principles and
practices. Health care organizations react to changes in health care policies and patient care guidelines
through ethics committees. The health care administrator has the job of ensuring ethical integrity throughout
the health care organization. At the clinical level, areas of ethical concern include patient autonomy,
confidentiality, informed consent, treatment termination, and advance consent (Morrison & Furlong, 2014).
The clinical level is where the majority of ethical issues in a health care organization occur.

Derived from ethical decision-making principles and legal and clinical practices, guidelines are used for
treatment termination. Through the ethical principle of autonomy, patients have the right to decide their
treatment plans or choose alternative methods of care. Issues do arise when inappropriate treatment is
demanded by patients.

According to the University of Washington School of Medicine’s Robert Pearlman (2013), traditional ethics
committees should have the following goals:

• uphold the rights of patients, fair policies, and procedures,
• support shared decision-making between health care providers and patients; and
• improve the ethical environment for health care organizations.

Health Care Reform

Health care reform has substantial implications for the future of the society in the United States and its
economic life (Sade, 2012). Health care reform is the governmental policies that aim to implement changes
through the methods of delivering health care services. The main objectives for health care reform are to
advance health care outcomes, increase the quality and value of health hcare services offered, and control
the spending by the United States government.

In order to improve health care outcomes for all individuals, ethical principles should be included in health
care reform. This includes vulnerable populations. Ethical principles, as discussed in earlier units, can be
applied to health care reform. Nonmaleficence cannot happen in a health care organization if there are
individuals who are not insured. Beneficence can be observed by populations who are not covered by
insurance (Morrison & Furlong, 2014). Other ethical principles that have impacted health care reform are
autonomy versus paternalism and distributive justice. Disadvantaged individuals tend to be high utilizers of
health care services.

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Patient Protection and Affordable Care Act

Individuals do not have a constitutional right to health care, as it is not written in the U.S. Constitution. The
federal government, however, does have the authority to collect taxes and regulate interstate commerce, and
this is how both Medicaid and Medicare are funded. Federal and state funding both contribute to Medicaid,
while Medicare is based only on federal funding. In 2010, President Barack Obama signed the Patient
Protection and Affordable Care Act (ACA), also known as Obamacare, into law. The primary goals of the ACA
were to grow the number of insured individuals in the United States, improve the quality of health care
offered, and reduce the costs associated with health care services (Manchikanti et al. 2017).

There are several key requirements of ACA:

• Medicaid eligibility for adults who do not have children,
• personal insurance requirements for legal immigrants and U.S. citizens,
• preventative health care services that have no co-pays, and
• private and public health insurance with no preexisting conditions clauses.

The ACA of 2010 created ethical arguments over several controversial topics. The ACA was deemed by
many to be unethical because the act required U.S. citizens to have health insurance and many individuals
believed that ACA was a violation of their right to choose. Some religious traditions include health care as a
right; however, many people argue that health and health care are social goods (Morrison & Furlong, 2019).
Due to the ethical debates surrounding the ACA, health care reform is still a very large topic at the forefront
today.

Since the passing of the ACA in 2010, the ACA has been applauded for increasing the number of insured
individuals in the United States. The majority of the expansion of people insured was because of Medicaid
enrollment. But the ACA has not worked well for the working and middle classes who receive much less
government support (Manchikanti et al., 2017). This has caused the enrollment in the health care marketplace
exchange to be lower than anticipated and has lowered the number of people accepting health benefits from
an employer. Further, the ACA widened the gap between patients who are actually receiving health care and
those having the ability to pay for health care (Manchikanti et al., 2017).

Tax Cut and Jobs Act

In 2017, President Donald Trump signed the Tax Cut and Jobs Act of 2017 (Tax Act). Part of this act took
effect January 1, 2018; however, the portion that affects health care coverage and the ACA were delayed until
2019 (Domenick, 2017). The Tax Act eliminated the individual mandate penalties of the ACA, and the
government will no longer collect individual mandate penalties if a person does not have health care
insurance coverage in 2019 and after. This does not mean that there is not a requirement for individuals to
have health care insurance; however, without penalties, there is no enforcement (Domenick, 2017).

We the Economy

For an example of patient cost in the United States health care system, please review the video: We the
Economy: This Won’t Hurt a Bit!-Why Is Healthcare So Expensive?

The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.

Conclusion

Ethics committee members must also be well-versed in ethical principles and complex decision-making
(Morrison & Furlong, 2014). Patients and their families play a vital role in addressing health care matters and
reform and should have ethics committee representation.

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References

American Medical Association. (n.d.). Ethics committees in health care institutions. https://www.ama-

assn.org/delivering-care/ethics/ethics-committees-health-care-institutions.

Domenick, L. (2017). 2019 repeal of the Affordable Care Act’s individual mandate penalties. Holland & Hart.

https://www.hollandhart.com/2019-repeal-of-the-affordable-care-acts-individual-mandate-penalties

Manchikanti, L., Helm, S., Benyamin, R. M., & Hirsch, J. A. (2017). A critical analysis of Obamacare:

Affordable care or insurance for many and coverage for few? Pain Physician, 20(3), 111–138.
https://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=20&page=111

Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning.

Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning.

Pearlman, R. A. (2013). Ethics committees and consultation. University of Washington.

https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/64

Sade, R. M. (2012). Health care reform: Ethical foundations, policy, and law. Journal of the American College

of Surgeons, 215(2), 286–296.